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Am J Neurodegener Dis 2012;1(2):152-159

Original Article
Vascular changes and brain plasticity: a new approach to
neurodegenerative diseases

Anya Topiwala, Klaus P Ebmeier

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.

Received May 25, 2012; accepted June 20, 2012; Epub July 23, 2012; published July 31, 2012

Abstract: The world’s population is aging, which will result in an increasing prevalence of neurodegenerative
diseases, such as dementia. Observations from functional brain imaging that older brains can be more active than
their younger counterparts challenge stereotypical ideas of aging. In those aging successfully, brain activation is more
anterior, less lateralized and more coordinated than in those at risk of, or suffering from, cognitive impairment. Several
theories have been proposed to explain these findings. One of the most enticing is the scaffolding theory, which posits
that the older brain is a plastic homeostatic organ, able to compensate for its deteriorating structure. However, with
aging also come diffuse vascular changes and the resulting white matter damage. This decreases the compensatory
capacity, and dementia can ensue. This and alternative hypotheses will be discussed, along with potential
methodological problems of this genre of study and with their clinical implications. (AJND1205002)

Keywords: Aging, dementia, imaging, scaffolding, plasticity, compensation

Address all correspondence to:
Dr. Klaus P Ebmeier
Department of Psychiatry
University of Oxford, Warneford Hospital
Oxford OX3 7JX, UK.
E-mail: klaus.ebmeier@psych.ox.ac.uk